Routine coronary angiographic follow-up and subsequent revascularization in patients with acute myocardial infarction

Abstract

The aims of the present study are to: (1) clarify the angiographic follow-up (AFU) rate after discharge; (2) elucidate the characteristics of those undergoing it; and (3) determine the impact of AFU on subsequent revascularization procedures among patients with acute myocardial infarction (AMI). Three thousand and twenty-one consecutive patients presenting within 48 h of AMI onset were enrolled from 17 centers in Japan between January 1999 and June 2001. To clarify the frequency of AFU and their characteristics, 2736 patients who survived at discharge were analyzed. Among 1160 patients matched by propensity score, the impact of AFU on subsequent revascularization was analyzed. Of 2736 patients, 1367 (50%) underwent AFU and constituted the lower-risk population. Of the 580 matched patient pairs, 120 (21%) in the clinical follow-up group and 198 (34%) in the AFU group underwent subsequent revascularization (hazard ratio 7.54; 95% confidence interval 5.74-9.91). Of the 198 patients in the AFU group, 157 (79%) underwent revascularization at the discretion of the responsible physician based on angiographic findings. Angiographic follow-up led to more subsequent revascularization. More evidence would be necessary to determine the effectiveness and the methods by which patients are selected.